Racial disparity in the relationship between hospital volume and mortality among patients undergoing coronary artery bypass grafting.
OBJECTIVE
To examine whether the volume-mortality relationship in coronary artery bypass grafting (CABG) differs by race and operative risk.


BACKGROUND
In-hospital mortality after CABG is inversely associated with hospital volume. Racial disparities exist in the outcomes of CABG, possibly due to blacks' high operative risk.


METHODS
We analyzed 71,949 CABG procedures performed between 2002 and 2005 at 93 academic medical centers participating in the University HealthSystem Consortium. In-hospital mortality was examined across hospital volume categories (very low, <100/yr; low, 100-299/yr; medium, 300-499/yr; and high, > or =500/yr) via logistic regression.


RESULTS
In-hospital mortality was 2.0% in whites and 2.8% in blacks. Controlling for patient risk, geographic region, and proportion of African American patients treated at the hospital, the benefit of higher volume was substantial for blacks but only modest for whites (race-by-volume interaction; P = 0.033). Odds ratios of mortality for increasing volume categories (compared with very low volume) were 0.46, 0.37, and 0.47 among blacks but only 0.85, 0.77, and 0.75 among whites. Racial disparities in mortality existed mostly in very low-volume hospitals. The differential volume effect across the 2 racial groups seemed to be primarily driven by regional patterns, as the volume effect was much more pronounced in the South and the Midwest (region by volume interaction; P = 0.033).


CONCLUSIONS
Blacks have greater reduction in mortality than whites by undergoing CABG at higher-volume hospitals, regardless of operative risk. Because of limited generalizability, these findings should be confirmed using more representative database.
Kim
Dae Hyun
DH
Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Daskalakis
Constantine
C
Lee
Andrew N
AN
Adams
Suzanne
S
Hohmann
Sam
S
Silvestry
Scott C
SC
Medvedev
Sofia
S
Whellan
David J
DJ
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000208:ethnology* / Q000601:surgery; D005260:Female; D054625:Healthcare Disparities; D017052:Hospital Mortality / Q000208:ethnology*; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012306:Risk; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*